CARE HOMES FOR OLDER PEOPLE
Larchwood 133 Yarmouth Road Thorpe St Andrew Norwich NR7 0RF Lead Inspector
Pearson Clarke Announced 14 April 2005 9.30am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Larchwood Address 133 Yarmouth Road Thorpe St Andrew Norwich NR7 0RF 01603 437358 01603 702046 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bondcare (Larchwood) Limited Ms Fran Gray Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (48) of places Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Up to forty-eight (48) Older People may be accomodated in the category OP Up to forty-eight (48) Service Users who have a physical disability may be accomodated in the category PD No more then 48 Service Users may be accomodated. Date of last inspection 10th November 2004 Brief Description of the Service: Larchwood Nursing and Residential Home is owned by Bondcare Ltd and is situated on the outskirts of Norwich, within Thorpe St Andrew. The home lies within easy access of a large supermarket, post office and small local shops. It is a two-storey building with access to the first floor by shaft lift and stairs. The home can accommodate up to 48 older people, with 25 nursing needs and 23 residential needs, with or without physical needs. The service has 36 single and 6 shared bedrooms. All the bedrooms have en-suite facilities. There is an enclosed patio area with seating and with raised flowerbeds that are accessible to wheelchair users. The home has car-parking facilities at the rear of the premises. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day and was an announced visit to the home. During the visit the inspector spent time with the service management, talked to the staff on duty, a number of residents and a selection of relatives and other visitors to the home. All communal areas of the home were seen and also a number of residents bedrooms. What the service does well: What has improved since the last inspection?
This was the inspectors first visit to the home, however having considered the findings of the previous inspection there is evidence that since the last inspection there has been a continued improvement in the management of the home. Work has been undertaken to ensure an open complaints culture and to ensure better communication with families of those living at Larchwood. Some redecoration has taken place and requirements arising from the last inspection have been addressed. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Admissions to the home are based on an assessment of the service users needs and wishes. EVIDENCE: Examination of a selection of the homes care plans showed that a needs based assessment was in place in all cases. The Inspector also spoke to the relative of a recently admitted resident who confirmed that the persons needs had been established and were being met. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 The health care needs of service users are being met. Service Users health, personal and social care needs are identified in a care plan. Service users are treated with respect, but care needs to be taken to ensure privacy is respected at all times. EVIDENCE: Individual plans of care are in place for all residents. Inspection of a selection of these showed the plans to be based on assessment and to contain risk assessments. The inspector talked to a number of residents and to relatives and visitors to the home. All of those spoken to felt that the home was meeting their needs and giving them the care that they expected to receive. Discussion with the manager indicated an appropriate approach to the promotion of residents health care needs and information seen in care plans supported this. Staff spoken to were aware of the importance of protecting residents privacy and residents confirmed that they normally felt that their privacy was respected by staff. However the inspector observed a member of staff entering a bedroom without knocking and awaiting permission to enter. Whilst this may have been an
Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 10 oversight it is important for all staff to ensure that this is always part of their practice and this should be reinforced by the homes management. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Residents are able to maintain contact with family, friends and representatives and receive a good range of meals. Since the last inspection the provision of stimulation and activity for residents has reduced and is no longer adequate. EVIDENCE: The inspector talked to 6 residents and 5 visitors to the home during the inspection. All of those visiting said that they felt free to come and go as they wished and the residents painted a similar picture. Visitors told the inspector that they were offered a hot drink when in the home and that they could have a meal if they wanted. The home has an open visiting policy and the inspector was told by one relative that they were able to continue helping with the personal care of their loved one. No one spoken to had any complaints about the quality or quantity of the food although some residents said they had little appetite these days. The homes chef was interviewed and told the inspector how he sees each new resident or their family to establish their individual likes and dislikes. The menus are designed by him in conjunction with the manager and show a good range of meals on offer. The chef confirmed that if the main meal is not wanted he will prepare what the resident requests as an alternative. Later discussion with residents confirmed this to be the case. The chef told the inspector that they mainly use fresh food and that his catering budget is adequate to offer good food.
Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 12 It was confirmed to the inspector that the activity co-ordinator was no longer at the home. Some of the residents and visitors spoken to talked of there being less activity available and the service needs to ensure that people are offered opportunities for entertainment and stimulation. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are taken seriously and are being addressed in an open manner. EVIDENCE: Most of the visitors and residents spoken to said that they would have the confidence to complain and felt their complaints would be acted on. The service has had more complaints than it would wish for over the last year, however the manager has worked hard to ensure that the home has an open complaints culture. As such she has written to the representatives of all residents asking encouraging them to tell her if they are unhappy about any aspect of care in the home. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,26 The home was clean and fresh with no unwanted odour. The call bell system continues to be intrusively noisy. EVIDENCE: The inspector toured all communal areas of the home and some bedrooms as part of the inspection. During this time he experienced no unwanted odour and all areas seen were clean and fresh. Whilst in the home he talked to a number of residents and their visitors and all expressed the opinion that they found the home to be like this on almost all occasions. The previous inspection had identified that the homes call bell system was very noisy and intrusive and in the inspectors opinion this remained the case. A recommendation to reduce the noise level arose from the last inspection and whilst the manager confirmed that they had explored ways to reduce noise the necessary work had not been carried out yet. Although residents did not identify this as a particular issue on this occasion in the inspectors opinion it is important and the recommendation is repeated. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 On the day of Inspection the Inspector found indicators that staffing levels are not adequate to meet the dependency levels of those cared for. EVIDENCE: Based on the staffing rota supplied to the inspector the service is meeting the expectations of the minimum staffing notice issued to them by their previous registration authority. However there were indicators that given the current levels of dependency this may be inadequate to meet the needs of those cared for at all times. During his time in the home the inspector observed that call bells were frequently ringing and staff response times often seemed lengthy. In conversations with residents and their visitors, staff were commended for their hard work and kindness, however they were also felt to be very busy most of the time. Staff interviewed also felt that their work load was very heavy and those who had worked at the home for some time believed that the dependency of those cared for had increased. Discussion with staff on duty indicated that in their opinion upwards of 75 of those cared for needed two carers at all times. The inspector was unable to carryout a detailed analysis of dependency in his time in the home and although consideration was given to requiring an increase in staffing levels a decision has been made to require the service to review dependency and staffing levels and to demonstrate to the commission that these are satisfactory. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 The homes management has improved, however the failure to recruit a deputy manager or have a clear management team undermines the ability to maintain those improvements. EVIDENCE: The Inspector formed the opinion that the homes management has improved over the last year. Most staff spoken to felt better supported and that there was clearer leadership in place. Visitors to the home also indicated that they felt that the home was improving. The requirements from the last inspection have been addressed and work has been undertaken to establish an open culture for dealing with complaints. However the management structure in the home is not robust. The provider has failed to recruit a deputy despite the efforts to do so and the current manager has indicated that they are working and are on call for very long periods and that this impacting on their effectiveness. In the inspectors judgement there is a real danger that
Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 17 improvements will not be maintained unless a satisfactory management structure is established and as such this matter should be a priority. Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 2 x x x x x x Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 12 Requirement The service management must reinforce to staff the importance of respecting service user privacy The home must review dependancy levels and based on the outcome submit details of adequate staffing to meet the needs of residents. The provider must introduce a management structure which allows for the effective management of the home at all times and allows the registered manager support. Timescale for action Immediate and on going 31st May 2005 2. 27 18 3. 32 18 30th June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 22 Good Practice Recommendations That the service ensure that a reasonable range of activity and stimulation is available to residents. That the service ensures that action is taken to reduce noise from the call bell system Larchwood I55s15652larchwoodv214394140405(4).doc Version 1.20 Page 20 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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